A prolapsed umbilical cord is almost always a medical emergency. Delayed intervention may harm the fetus.
What is an umbilical cord prolapse?
According to the medical definition, an umbilical cord prolapse occurs when the umbilical cord shifts during the birth process or as part of a premature rupture of membranes (tearing of the amniotic sac) so that it lies between the birth canal and the unborn child. See psyknowhow for Cryptitis Explained.
Since the pressure on the umbilical cord can lead to a lack of oxygen in the fetus, the prolapsed umbilical cord is usually treated by emergency medicine. Within Germany, a prolapsed umbilical cord occurs in about 0.3% of pregnancies.
Fetuses with deviating infant position are particularly affected; such a deviating child position can take the form of a slanting, foot or transverse position, for example. Umbilical cord prolapse also occurs more frequently in multiple births.
Causes
In medicine, a birth canal that is not sufficiently sealed by the fetus is considered a possible cause of a prolapsed umbilical cord. For example, the risk of an umbilical cord prolapse is increased in the case of premature births or fetuses that are smaller than average.
Other factors that can favor a prolapse of the umbilical cord are, for example, a very low-lying placenta (placenta) and/or a so-called hydramnios – the presence of an increased amount of amniotic fluid in the uterus.
If an umbilical cord prolapse occurs as a result of premature rupture of membranes, the event may be due to the fetus being pulled into the expectant mother’s pelvis by the sudden suction of the amniotic fluid; if the umbilical cord is below the fetus at this point, the unborn child’s body can put pressure on the umbilical cord and an umbilical cord prolapse occurs.
Symptoms, Ailments & Signs
A prolapsed umbilical cord can be identified by a variety of signs. The doctor usually first notices a drop in the heart rate of the embryo. This slows down the child’s heart rate and activity. On physical examination, the pulsating umbilical cord can be felt in front of the embryo, often by this time it has become entangled in the child’s limbs, torso, or neck.
If the umbilical cord is not disconnected immediately, there is an acute danger to life. As a result of the lack of oxygen and blood supply, brain cells die after just a few minutes. This often results in severe disability or even death of the child. If the umbilical cord wraps around the fingers or toes, fractures and, as a result, deformities can occur.
In the event of a prolapsed umbilical cord, a caesarean section must always be carried out. If this happens in time and the child is still supplied with sufficient oxygen, there will be no long-term effects. However, there may be delays in development in individual cases . In addition, a prolapsed umbilical cord usually results in a premature birth, which is always associated with certain risks. A prolapsed umbilical cord cannot be recognized externally. However, mothers often notice that the child no longer moves or suddenly panics.
Diagnosis & History
In order to diagnose an umbilical cord prolapse, a so-called cardiotocography is often carried out first; this is a procedure that makes it possible, for example, to check the heartbeat of an unborn child. Signs of a prolapsed umbilical cord include a slowed fetal heartbeat.
If there is a suspected diagnosis, the next step is for the attending gynecologist to scan the birth canal of the expectant mother to determine the position of a possibly prolapsed umbilical cord. If this examination step was not yet able to sufficiently secure a diagnosis, if the cervix is already sufficiently dilated, an amniotic fluid mirror, for example, is also possible.
The course of an umbilical cord prolapse is positively influenced above all by early medical intervention. If medical intervention is delayed, a prolapsed umbilical cord can eventually damage the fetus. In severe cases, a prolapsed umbilical cord can result in the death of the embryo.
Complications
A prolapsed umbilical cord is one of the most dangerous complications that can occur during childbirth. If the incident is not detected in advance during the cardiotocography, the failure to receive medical treatment or medical treatment that is too late can, in the worst case, result in serious injury or the death of the child. One sign may be premature rupture of membranes.
In this case, the expectant mother should be taken to the hospital in a lying position as soon as possible. Due to the rupture of membranes, the amniotic fluid pulls the fetus towards the mother’s pelvis. If the umbilical cord happened to be underneath the child at that moment, the fetus itself presses on the protruding umbilical cord. The mother can at least reduce the pressure in a lying position.
Whenever the umbilical cord prolapses, the oxygen and blood supply to the fetus is cut off. The child can either become severely disabled or even die as a result, so an emergency caesarean section is necessary. If, in the worst case, the child has not received oxygen for too long and dies, it must be resuscitated in the uterus.
This works, for example, with bronchodilator drugs. A caesarean section is unavoidable in the case of a prolapsed umbilical cord, since the umbilical cord makes natural birth through the vagina impossible.
When should you go to the doctor?
Since an umbilical cord prolapse is an emergency, immediate action must be taken if it occurs. Otherwise, fetal death will occur during or immediately after delivery. Since the mother-to-be is normally in the hands of a medically trained staff, the irregularity is noticed and dealt with by the staff.
If the pregnant woman notices anything special or abnormal during the birth process, she should immediately inform the nurses, midwives or doctors present. Although the health of mother and child is constantly monitored during the birth process, warning signals or changes communicated by the mother can be clarified and investigated more quickly.
In the case of a birth in an inpatient setting, in a birthing center or in the case of a planned delivery at home, a sufficient number of midwives are present. In the case of a spontaneous birth without the presence of trained personnel, an emergency service must be alerted.
Until he arrives, the instructions of the emergency doctor should be followed, since in severe cases there is a risk of death for mother and child. For anatomical reasons, a prolapsed umbilical cord cannot be treated by the person concerned. The mother-to-be is dependent on the help of other people and can only give them feedback on health changes, abnormalities or irregularities.
Treatment & Therapy
In most cases, a prolapsed umbilical cord requires a quick cesarean section. If the expectant mother has to be transported to the hospital with a prolapsed umbilical cord (which can be the case, for example, in the event of an unexpected rupture of membranes), transport in a lying position is often important; in this position, the pressure of the fetus on the prolapsed umbilical cord can be reduced.
In the event of an umbilical cord prolapse, the emergency medical measure of relocating the head of the fetus, which has penetrated the birth canal, back into the uterus also helps to relieve the prolapsed umbilical cord. In addition, the pelvis of the expectant mother is often elevated until the caesarean section takes place.
Supplemental administration of substances that suppress labor in the expectant mother (these substances are also known in medicine as tocolytics) can prevent the fetus’s head from pushing itself out of the uterus again.
If a fetus has already been severely deprived of oxygen as a result of a prolapsed umbilical cord, in some cases resuscitation (revival) of the fetus inside the uterus may be necessary; appropriate resuscitation can be done, for example, with the help of drugs that cause the bronchi to dilate.
Outlook & Forecast
A prolapsed umbilical cord can often be remedied by positioning the pregnant woman in an elevated position or on her side. The birth can take place vaginally under supervision of the child and is usually successful. If there are complications during or after the umbilical cord prolapse, a caesarean section is performed. If necessary, medication such as Fenoteral must be prescribed.
The prognosis of an umbilical cord prolapse is very good these days. In most cases, a high or side position is sufficient to enable a natural birth. Nevertheless, a prolapsed umbilical cord means life-threatening danger for the child and possibly also for the mother. The faster the prolapsed umbilical cord is identified and repaired, the better the chances of a natural birth, in which the child is born healthy. If the course is positive, the child and mother do not have to expect any long-term consequences. However, a difficult birth can mean a trauma for the mother, which must be worked through with therapeutic support.
In principle, there is a chance of recovery if the birth can be initiated as planned and no further incidents occur. If the membranes rupture prematurely, there is a risk that the fetus will die in the womb.
Prevention
If premature rupture of membranes occurs during a stage of pregnancy when the head of the embryo has not yet positioned itself in the pelvis, transport to a hospital in the prone position can help prevent an umbilical cord prolapse in the first place. Regular check-ups during pregnancy can diagnose any fetal position anomalies that may increase the risk of umbilical cord prolapse.
Aftercare
In most cases, the measures and options for direct follow-up care in the event of a prolapsed umbilical cord are significantly limited or, in many cases, are not even available to the patient. For this reason, a doctor must be consulted as early as possible with this disease in order to prevent further damage to the child. In the worst case, this can lead to the death of the child and thus to a stillbirth.
The earlier the prolapsed umbilical cord is recognized and treated, the better the further course of this disease is usually. The symptoms themselves are usually alleviated by a caesarean section. After such a procedure, the mother should definitely rest and rest.
Efforts or stressful and physical activities should be avoided in order not to unnecessarily burden the body. Regular checks and examinations are still very important after the birth of the child in order to identify other complaints and damage at an early stage and then to treat them. In the event of a prolapsed umbilical cord, the parents themselves are dependent on the help of their own family, which above all can prevent depression and other psychological upsets.
You can do that yourself
The occurrence of an umbilical cord prolapse can hardly be prevented by the woman in advance, and even if this complication occurs, it is professional medical help that the pregnant woman and, above all, the child, need. Nevertheless, there are a few things that the woman can keep in mind when it comes to the prolapsed umbilical cord.
This is primarily the observance of regular medical check-ups. Gynecologists can use the ultrasound images to assess the position of the child’s head and the placenta and thus the risk of a prolapsed umbilical cord. Otherwise, it makes sense for a pregnant woman to always consult a doctor or midwife if the symptoms are unclear. This is especially true for twin pregnancies. The woman can also have the doctor or midwife show her how the pulsation of the umbilical cord can be felt and, if in doubt, check it.
If membranes rupture prematurely, the risk of an umbilical cord prolapse increases rapidly. In these cases, the pregnant woman can help herself and her child by lying down and elevating the pelvis. The wrong reaction is to get to the clinic quickly by car in a sitting position, supposedly to save time. Self-help with a prolapsed umbilical cord is the lying position. The pregnant woman is then taken to the hospital in a lying position in the ambulance.
